Colonial Soccer Club Men's Soccer Program

Please complete this form to ensure that your enlistment in the Colonial Soccer Men's Program and placeed on an email list which will inform you about practices, training, tryouts, games, and organized leagues.

* Required

First Name
*

This is a required question

Last Name
*

This is a required question

Address
*

This is a required question

City
*

This is a required question

State
*

This is a required question

Postal Code
*

This is a required question

Home Telephone
*

Provide the home telephone number.

This is a required question

Work Telephone

Provide the work telephone number

This is a required question

Mobile Telephone
*

Provide the Mobile telephone number

This is a required question

Primary e-mail address
*

Provide the e-mail address that you check most often

This is a required question

Secondary e-mail address?

Provide an alternate e-mail address

This is a required question

Date of Birth?
*

MM / DD / YYYY

This is a required question

Years of Experience?
*

Choose only one.

None

1 to 5 Years

6 to 10 Years

11 to 15 years

15 to 20 years

Other:

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Rate Your Skill
*

Must Choose One!

1

2

3

4

5

6

7

8

9

10

Worst

Best

This is a required question

Team Partcipation?

Choose all the apply...

Youth Recreation

Youth Travel

High School

College

Division One

Division Two

Division Three

This is a required question

Coaching Experience?

Choose all the apply...

Youth Recreation

Youth Travel

High School

College

Other:

This is a required question

Coaching License?

If you have completed any coaching classes or licenses explain below...

This is a required question

Additional Soccer Information:

Provide any team or club partcipation that the coaches should know about you.

This is a required question

Type of Men's Soccer You Would Like to Participate?

Choose all that apply...

Practice

Pick-up Games

Organized Leagues

Other:

This is a required question

If answer above was Organized Leagues?

Choose all that apply...

ICSL Premier (Sundays)

ICSL Ultra (Sundays, Very Competitive, Partcipate in State Cups)

Over -30 (Friday Nights)

Over-40 (Sunday Nights After 5PM)

This is a required question

Days of the Week Available?

Check all that apply...

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Other:

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How you heard about Plymouth Soccer?
*

Current Players

Website

Organized League (ICSL)

Organized League (UNITED)

Other:

This is a required question

AUTHORIZATION TO PLAY, MEDICAL RELEASE, AND WAIVER

With the answering the check box below, permission is hereby granted to participate in all practice sessions, games and other activities involving the Colonial Soccer Club. This permission extends to any travel to and from any and all practice sessions, games, tournaments and other activities sponsored and arranged by Colonial Soccer Club, US Club Soccer, EPYSA, EPSA, US Youth Soccer, or the USSF, or any affiliate of any of these named groups.
This permission is granted without reservation. Recognizing the risks presented by the competitive contact sport of soccer, the check box(s)below indicates a knowing, voluntary release of any claim which might be asserted against the any of the above named entities, their officers, administrative assistants, coaches, assistant coaches, managers, sponsors, chaperones, designated drivers, volunteers, and other agents representing those entities and its officers or agents or representatives. By waiving any rights to assert a claim, I am agreeing to release absolve, indemnify and hold harmless any and all parties previously mentioned for any and all liability arising from any injuries incurred by participant in the Club, its games, practices, tournaments, etc... My waiver expressly means that I accept and assume all risks and hazards inherent in and related to the activities of the participants engagement in soccer activity as herein noted, including any travel to and from or participation in any activities sponsored and arranged by any of the above listed entities.

Required Answer!
*

Yes, I agree

No, I disagree

This is a required question

Type Full Name
*

This is a required question

EMERGENCY MEDICAL TREATMENT AUTHORIZATION

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, Colonial Soccer Club, US Club Soccer, EPYSA, EPSA, US Youth Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in Plymouth Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.